Adolescent Substance Abuse

1
Adolescent Substance Abuse
What We Know and How to Prevent It!
Michael T. Flaherty, Ph.D. Executive
Director/Clinical Psychologist
Institute for Research, Education and Training in
Addictions (IRETA), Regional Enterprise Tower,
425 Sixth Avenue, Suite 1710Pittsburgh, PA
15219, [phone] www.ireta.orgm,
flahertym_at_ireta.org
2
Some Background and Quick Premises

• Addiction to illegal drugs is Americas No. 1,
  preventable, health problem.
• Addiction to any drug (alcohol, tobacco, illicit
  drug) is a chronic illness requiring a continuum
  of care.
• The abuse of alcohol and tobacco is a critically
  important, greatly under-funded, National
  problem. 50-75 of adolescents in psychiatric
  care use substance abuse.

3
Some Background and Quick Premises(Continued)

• Drug use is drug abuse and, however it begins,
  leads to dependence (psychological) and
  potentially addiction.
• The solution of this problem in our society
  requires a greater partnership of the community
  with our schools, providers, policy makers,
  funders, scientists and media.

4
Adolescent Substance Abuse

• Despite reports of leveling off (see PPG 1/5/03),
  substance abuse by adolescents remains high.
• More than 90 of adults with current substance
  abuse problems began use before the age of 18
  one-half before the age of 15!
• In a 2001 national survey, 23 of 8th graders
  reported being drunk at least once .. with 21.5
  reporting current alcohol use.

5
Adolescent Substance Abuse(Continued)

• 54 of all high school graduates in the U.S. have
  used illicit drugs by the time they graduate.
• Among 8th graders, illicit drug use is higher in
  Anglo-Americans than in African-Americans in
  fact, suburban America is both at greater risk
  and a higher target for drugs.

6
The Treatment Continuum for Adolescents

• Outreach - School/Community/CJ
• Assessment - Public/Private/CJ
• Treatment - Public/Private/CJ

7
The Treatment Continuum for Adolescents(Continued
)

1. Outpatient - Standard (1 x wk) - Intensive OP (3
   x wk) - Partial Hosp. (3 x wk)
2. Residential - Detox (1-2 days) - Rehab (1-4
   wks) - Stepdown/Halfway (2-6 mos)

8
The Treatment Continuum for Adolescents(Continued
)

• Inpatient - Detox (2-3 Days)(Hospital) - Rehab (1
  2-21 Days)
• Aftercare - Up to 12 months in Continuumat
  progressively less restrictive care.
• Self-Help - AA, NA, Al-Anon, Al-Ateen (Not
  Treatment)

9

• Scientific studies have now documented that
  adolescents are at-risk for illicit alcohol/
  tobacco/drug use as a result of a unique
  trajectory of
• Biology
• Environment
• Development

10

• The above factors combine during the critical
  adolescent years to create a heightened risk
  period often made obvious by increased
  externalized behavior and manifest opposition,
  secrecy and/or aggression.
• Ref Maziade, M., Should Adverse Temperament
  Matter to the Clinician? in Temperament in
  Childhood, 1989, New York Wiley

11
Who is Most At Risk Among Adolescents?

1. Low Self Esteem
2. Poor Coping Skills
3. Low Behavioral Self Regulation
4. Social Skills Deficits

Ongoing interaction with the environment
interacting with individual bio-behavioral
aspects.
Ref. Tarter, et.al., Psychology of Addictive
Behaviors, December, 2002
12
Who is Most at Risk Among Adolescents?(Continued)

• If any use occurs as a result of a composite,
  unique interaction between environment,
  development and biology, and we know who is at
  most risk, can we prevent it?

Defined as Tobacco, Alcohol or Illicit Drug.
13
Yes!

• A review of the current literature indicates that
  we can best intervene or disrupt the drug use
  trajectory by

14
1. Building Social Competence

• Building self-understanding.
• Owning ones perspective.
• Building social problem-solving skills.
• Having quality child-environment interactions.
• Teaching addiction/drug impact.

15
2. Developing School Bonding and Achievement

• Building a commitment to school/self.
• Build methods that increase bond to school and
  the opportunity for academic success.
• Build aspiration for success.
• Motivate, motivate motivate.
• Be long-term.

Maladjustment in elementary school is a high
predictor/risk factor for Substance Abuse. Low
school engagement correlates to low self-esteem,
low self-expectation and high association to
deviant peers all of which greatly increases
likelihood of drub abuse.
16
3. Teaching Self-Regulation

• Teach methods and reasoning for emotional
  regulation, anger management and impulse control.
• Teach normative role modeling and problem solving
  skills.
• Improve self-control/executive regulation.
• Be age specific and culturally sensitive.
• Be interactive.
• Teach skills.

17
4. Support and Build Parental/ Adult Involvement

• Nothing builds child and adolescent resiliency
  better than qualitative parental/child or
  adult/child relationship!
• The absence of parental involvement highly
  predicts Substance Abuse use/psychological
  dysregulation. Parental/child conflict with low
  involvement highly predicts delinquency and
  illicit drug use.

18

• Overall, addressing the above four interventions
  in a sustained manner proportionally reduces, in
  a significant manner, the likelihood of
  adolescent substance abuse, aggression and social
  deviancy.
• Ref Tarter, R., Predictor Variables by
  Developmental Stages A Center for Sustained
  Abuse Prevention Multi-State Study in Psychology
  of Addictive Behaviors, Vol. 16, No. 45, 2002.

19
Four Prevention Techniques with Adolescents

1. Building Social Competence
2. Developing School Bonding and Achievement
3. Teaching Self-Regulation
4. Supporting and Building Parental/Adult-Child
   Involvement

20
Other Sources of Help/Information

• Allegheny County Treatment System Handout
• Institute for Research, Education and Training in
  Addictions (IRETA) 412-391-4449 www.ireta.org
• National Institute on Alcoholism
  www.niaaa.nih.gov
• Making the Grade, www.drugstrategies.org
• Join Together www.jointogether.org
• Center for Substance Abuse Prevention
  www.samhsa.gov/centers/csap
• Community Anti-Drug Coalitions of America
  www.cadea.org